脊髓髓内胶质瘤的外科治疗——附56例临床分析

背景与目的:脊髓胶质瘤的治疗一直为临床难题,对分化良好的低级别髓内星形细胞瘤手术治疗依然可以取得良好效果,但分化差的高级别髓内星形细胞瘤或胶质母细胞瘤预后很差,放疗效果不确定。本文旨在探讨脊髓质瘤的治疗方法及预后。方法:本文总结了56例脊髓髓内胶质瘤的临床资料,对其病理类型、性别比例、年龄构成、发生部位、影像特征、手术技术、术中电生理监护、术后并发症、疗效预后等进行了讨论分析。结果:肿瘤近全切除及大部分切除为26例(46%),其余病例(54%)为部分切除或活检。55例患者行椎板切除减压,1例肿瘤边界清楚,镜下全切除肿瘤,术中行椎板复位。术后随访资料显示:星型细胞瘤Ⅰ~Ⅱ级,术中肿瘤边界相对清楚且近全切除的26例患者,术后3个月运动、感觉等功能有明显改善,其余肿瘤部分切除或活检的患者神经功能无显著改变。55例患者在术后3周至3个月内行普通放疗。脊髓圆锥部位的肿瘤,术后大小便困难发生率高达60%。结论:有相对边界的髓内星形细胞瘤手术治疗为最佳选择,术后辅助放疗,预后良好。恶性髓内胶质瘤手术以明确诊断,部分切除加脊髓减压为原则,手术难以改善神经功能状况,总的预后差。

Surgical Treatment for Intramedullary Spinal Cord Tumors:56 Cases Experience

BACKGROUND & OBJECTIVE:Surgical treatment for intramedullary spinal tumors, especially glioma is still a challenge. For low-grade intramedullary spinal astrocytomas, surgical outcome is quite good. But for malignant gliomas, the postoperative prognosis is dismal. The effect of radiotherapy for intramedullary spinal gliomas is controversial. METHODS: We reviewed a series of 56 patients with intramedullary spinal gliomas. We studied their pathological results, surgical techniques, intraoperative neuromonitoring and complications.RESULTS: Near-total removal of the tumor was achieved in 46% of the patients. While partial resection or biopsy was performed in the rest of the patients. For low-grade intramedullary spinal astrocytomas, we proposed maximum removal of the tumors. For malignant tumors, laminectomy, biopsy and duroplasty is the treatment of choice.CONCLUSIONS: For low-grade intramedullary spinal gliomas , maximum surgical resection of the tumor is surgical strategy. For manignant intramedullary spinal gliomas, biopsy and laminectomy is proposed.